Cheryl Cohen1,2, Akhona Tshangela1, Ziyaad Valley-Omar1,3, Preetha Iyengar4, Claire Von Mollendorf1,2, Sibongile Walaza1,2, Orienka Hellferscee1,5, Marietjie Venter1,6, Neil Martinson7, Gethwana Mahlase8, Meredith McMorrow9,10, Benjamin J Cowling11, Florette K Treurnicht1, Adam L Cohen9,10,12, Stefano Tempia1,9,10. 1. Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa. 2. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 3. Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa. 4. District of Columbia Department of Health, Washington. 5. School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 6. Centre for Viral Zoonoses, Department of Medical Virology, University of Pretoria. 7. Perinatal HIV Research Unit, Klerksdorp-Tshepong Hospital, North West Province, South Africa. 8. Pietermaritzburg Metropolitan, KwaZulu-Natal, South Africa. 9. Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia. 10. Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa. 11. WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong. 12. Expanded Programme on Immunization, Department of Immunizations, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland.
Abstract
BACKGROUND: We estimated the household secondary infection risk (SIR) and serial interval (SI) for influenza transmission from HIV-infected and HIV-uninfected index cases. METHODS: Index cases were the first symptomatic person in a household with influenza-like illness, testing influenza positive on real-time reverse transcription polymerase chain reaction (rRT-PCR). Nasopharyngeal swabs collected from household contacts every 4 days were tested by rRT-PCR. Factors associated with SIR were evaluated using logistic regression. RESULTS: We enrolled 28 HIV-infected and 57 HIV-uninfected index cases. On multivariable analysis, HIV-infected index cases were less likely to transmit influenza to household contacts (odds ratio [OR] 0.2; 95% confidence interval [CI], 0.1-0.6; SIR 16%, 18/113 vs 27%, 59/220). Factors associated with increased SIR included index age group 1-4 years (OR 3.6; 95% CI, 1.2-11.3) and 25-44 years (OR 8.0; 95% CI, 1.8-36.7), and contact age group 1-4 years (OR 3.5; 95% CI, 1.2-10.3) compared to 5-14 years, and sleeping with index case (OR 2.7; 95% CI, 1.3-5.5). HIV infection of index case was not associated with SI. CONCLUSIONS: HIV-infection was not associated with SI. Increased infectiousness of HIV-infected individuals is likely not an important driver of community influenza transmission.
BACKGROUND: We estimated the household secondary infection risk (SIR) and serial interval (SI) for influenza transmission from HIV-infected and HIV-uninfected index cases. METHODS: Index cases were the first symptomatic person in a household with influenza-like illness, testing influenza positive on real-time reverse transcription polymerase chain reaction (rRT-PCR). Nasopharyngeal swabs collected from household contacts every 4 days were tested by rRT-PCR. Factors associated with SIR were evaluated using logistic regression. RESULTS: We enrolled 28 HIV-infected and 57 HIV-uninfected index cases. On multivariable analysis, HIV-infected index cases were less likely to transmit influenza to household contacts (odds ratio [OR] 0.2; 95% confidence interval [CI], 0.1-0.6; SIR 16%, 18/113 vs 27%, 59/220). Factors associated with increased SIR included index age group 1-4 years (OR 3.6; 95% CI, 1.2-11.3) and 25-44 years (OR 8.0; 95% CI, 1.8-36.7), and contact age group 1-4 years (OR 3.5; 95% CI, 1.2-10.3) compared to 5-14 years, and sleeping with index case (OR 2.7; 95% CI, 1.3-5.5). HIV infection of index case was not associated with SI. CONCLUSIONS:HIV-infection was not associated with SI. Increased infectiousness of HIV-infected individuals is likely not an important driver of community influenza transmission.
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